DR. MICHAEL BRYON SPACKMAN (NPI# 1386887032) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1386887032 |
| Entity Type | Individual |
| Full Name | DR. MICHAEL BRYON SPACKMAN |
| Credential | MD |
| Practice Address |
360 E Montvue Dr Suite 100 Meridian ID 83642 |
| Mailing Address |
2835 N Tanglerose Pl Eagle ID 83616-5796 |
| Practice Telephone | 2088552900 |
| Mailing Telephone | 9522395080 |
| Enumeration Date | 2009-04-10 |
| Last Update Date | 2018-07-11 |
| Gender Code | M |
| Is Sole Proprietor | Y |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| Y | 2081P2900X |
Physical Medicine & Rehabilitation Specialization: Pain Medicine |
M11335 | ID | Allopathic & Osteopathic Physicians |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1770712978 | Michael Lee Spackman | Massage Therapist | 3112 O St, Suite #1, Sacramento, CA 95816-6542 | 2009-07-08 |
| Street Address |
360 E MONTVUE DR SUITE 100 |
| City | MERIDIAN |
| State | ID |
| Zip Code | 83642 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1275578908 | Edwin Merle Clark | Orthopaedic Surgery | 360 E Montvue Dr, Suite 100, Meridian, ID 83642-6318 | 2006-06-17 |
| 1952701401 | Southern Idaho Health Partners LLC | General Practice | 360 E Montvue Dr, Meridian, ID 83642-6318 | 2014-09-02 |
| 1033454426 | Sari Bianca Lavarias | Physician Assistant | 360 E Montvue Dr, Meridian, ID 83642-6318 | 2012-12-11 |
| 1477843811 | Tara Osborne | Physical Therapist | 360 E Montvue Dr, Suite 100, Meridian, ID 83642-6318 | 2011-04-18 |
| 1770747404 | Christian Vanderford | Physical Therapist | 360 E Montvue Dr, Ste A, Meridian, ID 83642-6318 | 2008-07-11 |
| 1073776258 | Liang Wu | Internal Medicine | 360 E Montvue Dr, Meridian, ID 83642-6318 | 2008-07-08 |
| 1235338682 | Kelli Elizabeth Debooy | Physical Therapist | 360 E Montvue Dr, Suite 100, Meridian, ID 83642-6318 | 2007-07-16 |
| 1689701260 | Shannon L Gardiner | Physician Assistant | 360 E Montvue Dr, Suite 100, Meridian, ID 83642-6318 | 2007-02-28 |
| 1659380269 | Spine Institute of Idaho P A | Orthopaedic Surgery | 360 E Montvue Dr, Suite 100, Meridian, ID 83642-6318 | 2006-08-05 |
| 1962447169 | Samuel Steven Jorgenson | Orthopaedic Surgery | 360 E Montvue Dr, Suite 100, Meridian, ID 83642-6318 | 2006-06-19 |
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| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1174145684 | Ikdo South Meridian LLC | Dentist | 3839 E Amity Rd, Meridian, ID 83642 | 2020-05-07 |
| 1073133328 | Prescription Pad LLC | Pharmacy | 885 S Vanguard Way, Meridian, ID 83642 | 2020-04-16 |
| 1609412683 | Meridian Advanced Psychiatry, LLC | Psychiatry & Neurology | 1672 S Woodsage Ave., Meridan, ID 83642 | 2019-11-25 |
| 1194378927 | Sergey Tsema | Occupational Therapist | 1259 E Pisa St, Meridian, ID 83642 | 2019-07-21 |
| 1003478629 | Chris R Jackson | Dentist | Isu Family Dentistry, 1311 E Central Dr, Meridian, ID 83642 | 2019-07-03 |
| 1285293118 | Morgan Family Medicine | Nurse Practitioner | 1660 S Woodsage Avenue, Meridian, ID 83642 | 2019-06-13 |
| 1033772793 | Nugen Healthcare, Pllc | Registered Nurse | 2177 S Spoonbill Ave, Meridian, ID 83642 | 2019-04-18 |
| 1811471790 | Courtney Crossland | Physician Assistant | 4949 S Hillsdale Ave., Meridian, ID 83642 | 2018-09-18 |
| 1841771938 | Katelyn Perry | Counselor | 2068 S. Eagle Rd., Meridian, ID 83642 | 2018-08-27 |
| 1114406204 | Gem Prep: Meridian LLC | Case Management | 2750 E.gala Ct., Meridian, ID 83642 | 2018-08-09 |
| Find all providers in zip 83642 | ||||
| Taxonomy Code | 2081P2900X |
| Grouping | Allopathic & Osteopathic Physicians |
| Classification | Physical Medicine & Rehabilitation |
| Specialization | Pain Medicine |
| A physician who provides a high level of care, either as a primary physician or consultant, for patients experiencing problems with acute, chronic or cancer pain in both hospital and ambulatory settings. Patient care needs may also be coordinated with other specialists. |
| Notes: Source: American Board of Medical Specialties, 2007. www.abms.org [7/1/2007: definition changed, source changed] Additional Resources: American Board of Physical Medicine and Rehabilitation, 2007. http://www.abpmr.org/. Board certification for Medical Doctors (MDs) is provided by the American Board of Physical Medicine and Rehabilitation. A subspecialty certificate was approved by the ABMS in 1999. ACGME Accredited Residency Program Requirements: Proposal under development. |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1497949705 | Idaho Physical Medicine and Rehabilitation Pa | Physical Medicine & Rehabilitation | 3551 E Overland Road, Meridian, ID 83642 | 2007-08-29 |
| 1427151539 | Beth S Rogers | Physical Medicine & Rehabilitation | 360 E Montvue Dr Ste 100, Meridian, ID 83642-6318 | 2006-09-06 |
| 1396945069 | James H Morland, Md | Physical Medicine & Rehabilitation | 3875 E Overland Rd, Suite 200, Meridian, ID 83642-9005 | 2007-07-20 |
| 1215975164 | James H Morland | Physical Medicine & Rehabilitation | 3875 E Overland Rd, Suite 200, Meridian, ID 83642-9005 | 2006-06-03 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598305922 | Rebekah Guy | Physical Medicine & Rehabilitation | 115 W Main St Ste 201, Boise, ID 83702-7303 | 2020-01-14 |
| 1417267329 | Idaho Pain Clinic Pllc | Physical Medicine & Rehabilitation | 1327 Superior St Ste 101, Sandpoint, ID 83864-2742 | 2010-10-13 |
| 1790825842 | Mark J Harris | Physical Medicine & Rehabilitation | 600 W Robbins Rd Ste 300, Boise, ID 83702-4568 | 2007-02-07 |
| 1780769075 | Kevin S Hill | Physical Medicine & Rehabilitation | 777 Hospital Way, Suite G15, Pocatello, ID 83201-5175 | 2006-10-26 |
| 1609885870 | N S Support LLC | Physical Medicine & Rehabilitation | 6140 W Curtisian Ave, Suite 400, Boise, ID 83704 | 2006-08-06 |
| 1710995170 | Saint Alphonsus Physicians, Pa | Physical Medicine & Rehabilitation | 901 N Curtis Rd, Suite 304, Boise, ID 83706-1338 | 2006-08-03 |
| 1023024684 | Center for Pain Care P A | Physical Medicine & Rehabilitation | 115 W Main St, Suite 102, Boise, ID 83702-7302 | 2006-08-01 |
| 1154345585 | Clinton Mallari | Physical Medicine & Rehabilitation | 115 W Main St, Suite 102, Boise, ID 83702-7302 | 2006-07-27 |
| 1356377535 | Daniel Richard Marsh | Physical Medicine & Rehabilitation | 8950 W Emerald St, Ste 168, Boise, ID 83704-8296 | 2006-06-23 |
| 1497711329 | Idaho Physical Medicine and Rehabilitation Pa | Physical Medicine & Rehabilitation | 600 Robbins Rd, Suite #300, Boise, ID 83702-4539 | 2006-04-20 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.